UNIT II: NURSING AS AN ART Art It is a common assumption that nursing is an art.

. Art in this sense is sometimes taken to mean a fine art, and sometimes a skill or craft. Caring Means that people, relationships, and things matter. Its a central to all helping professions and enables persons to create meaning in their lives. Caring is helping others to grow. Reason why Nursing is an Art Nursing is the art of caring. That is what makes it an art, because you can not learn to care from a book just as you can not learn to paint or draw from a book you must be born with some kind of talent for it. Caring is an art so nursing is an art. Caring: as an integral Component of Nursing Caring is a universal value that directs nursing practice. Caringbeing willing and able to nurture othersis a hallmark of the effective nurse. Providing emotional support is central to the act of caring. Caring is more than an intuitive process; it can be learned both intellectually and interpersonally. One learns caring by interacting with others who demonstrate caring. When nurses exhibit caring behaviors, they are serving as role modelsto students, colleagues, clients, and families. Respect for persons as caring individuals and respect for what matters to them assumptions are underlying the theory of nursing as caring. By living nursing as caring, the nurse establishes a mutual relationship of trust and respect with the client. Through fully appreciating the life-world of others, the nurse energizes self and others to grow as caring persons. Caring is a process and an art that requires commitment and knowledge. Caring is a combination of behaviors and attitudes. The way in which nursing actions are implemented expresses caring

Nursing behaviors that demonstrate caring: Introduce self to client. Call clients by their preferred names. Spend time with the client to review the plan of care.

Self- Awareness Concept Self-awareness has long been addressed as fundamental for the professional nurse with the accepted view that self-awareness will lead to greater competence. Self-awareness is a dynamic, transformative process of self. Self-awareness is the use of self-insights and presence knowingly to guide behavior that is genuine and authentic to create a healing interpersonal environment.

Self-Enhancement A type of motivation that works to make people feel good about themselves and to maintain self-esteem. Involves a preference for positive over negative self-views. The goal is to facilitate growth and development. Communication Any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including nursing. Therapeutic Communication Promotes understanding and can help establish a constructive relationship between the nurse and the client. A process in which the nurse consciously influences a client or helps the client to a better understanding through verbal or nonverbal communication. Therapeutic communication involves the use of specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect. Purpose: a. Collecting information to determine illness, b. Assessing and modifying behavior, and c. Providing health education. Components of Therapeutic Communication Active listening (concentrating exclusively on what client is saying) can be promoted by:

Facing the client Using moderate eye contact Removing physical barriers Maintaining open body posture Leaning forward

Active observation Means watching the speakers nonverbal actions as he or she communicates.

Criteria for Effective Verbal Communication 1. Pace and Intonation - Pace and Intonation will modify the feeling and impact of the message. The intonation can express enthusiasm, sadness 2. Simplicity - Simplicity includes the use of commonly understood words, brevity, and completeness. - Nurses need to learn to select appropriate, understandable terms based on the age, knowledge, culture, and education of the client. 3. Clarity and Brevity - Clarity is saying precisely what it meant; Brevity is using the fewest words necessary. The result is a message that is simple and clear. - To ensure clarity in communication, nurses also need to speak slowly and enunciate carefully. 4. Timing and Relevance - Nurses needs to be aware of both when communicating with clients. The timing needs to be appropriate to ensure that words are heard. Moreover, the message needs to relate to the person or to the persons interest and concern - This involves sensitivity to the clients needs and concerns. 5. Adaptability - Spoken message needs to be altered in accordance with behavioral cues from the client. - What the nurse says and how it is said must be individualized and carefully considered. This requires astute assessment and sensitivity on the part of the nurse. 6. Credibility - Credibility means worthiness of belief, trustworthiness and reliability. - It is the most important criterion of effective communication. - Nurses foster credibility by being consistent, dependable and honest. - The nurse to be liable on being discussed and to have accurate information. 7. Humor

- The use of humor can be positive and powerful in the nurse-client relationship, but it must be used with care. - Humor can be used to help clients adjust to difficult and painful situations. - When using humor, it is important to consider the clients perception of what is considered humorous. Communicating with people who are: 1. Physically Challenged a. Language Deficits Determine the clients primary language for communicating and whether a fluent interpreter is required b. Sensory Deficits The ability to hear, see, feel and smell are important adjuncts to communication. Deafness can significantly alter the message the client receives; Impaired visions alters the ability to observe non verbal behavior such as a smile or a gesture; Inability to feel and smell can impair the clients capabilities to report injuries or detect the smoke from a fire. Nursing Intervention: Blind Patient Always speak to the patient when you enter the room so he will know who is there. Speak directly to the patient; do not turn your back. Speak to the patient in a normal tone of voice; he is blind, not deaf. Speak to the patient before touching him/her. Offer to help with arrangements for patients who may enjoy hearing tapes or reading Braille literature.

Deaf Patient

Look directly at the patient when speaking with him/her. Do not cover your mouth when speaking because the patient may read lips. If the patient does not lip-read, charts with pictures may be used, or simply writing your questions or comments on a piece of paper may be helpful. Charts with hand signs are available at the local society for deafness and/or hearing preservation.

For clients with severe hearing impairments, follow these steps: Look for Medic-Alert bracelet (or necklace or tag) indicating hearing loss. Determine whether the client wears a hearing and whether it is functioning. Observe whether the client is attempting to see your face to read lips. Observe whether the client is attempting to use hands to communicate with sign language.

2. Cognitively Challenged Any disorder that impairs cognitive functioning (e.g., cerebrovascular disease, Alzheimers disease and brain tumors or injuries) may affect the clients ability to use and understand language. The nurses assesses whether these clients respond when asked a question and if so, assess the following: a. Is the clients speech fluent or hesitant? b. Does the client use words correctly? c. Can the client comprehend instructions as evidenced by following directions? d. Can client repeat words or phrase? e. Nurses also assess the clients ability to understand written words. When client is unconscious: The nurse looks for any indication that suggests comprehension of what is communicated. Ask a question like can you hear me? and watch for a non-verbal response such as a nod of the head for yes or a shake for no.

3. Aggressively Challenged Perceived as a personal attack by the other person because aggressive communication humiliates, dominates, controls, or embarrasses the other person. Certain techniques that is more helpful than others in achieving this goal: 1. Third-Person Technique

Method used to help de-escalate an aggressive patient. Involves asking another qualified nurse or staff member who was not there at the beginning of the conflict to enter the situation and attempt to speak to the patient. This allows for someone neutral to the situation to calmly talk with the patient. (The person acting as the negotiator should use therapeutic communication techniques and try to develop a rapport with the patient to come to a peaceful resolution to the situation.)

2. Techniques to Employ

A nurse should strive to remain an arm's length from an aggressive patient and she should try to maintain a calm demeanor. Acknowledge the patient's emotion so that he knows he is being heard. Use active listening skills by maintaining eye contact and paraphrasing what the patient is saying. Ask open-ended questions to find out the root cause of the anger. If an apology is warranted, then apologize, but do not lie. Set firm limits on what behavior is acceptable in the exchange. Always keep an exit lane to the door open. 3. Techniques to Avoid

Do not touch the patient or attempt to restrain him by hand. This may cause him to become physical. Do not try to interrupt a tirade with the truth. It will only make him feel as if you aren't listening and may make him angrier. Allow the patient to use any language he wants because scolding him may only make things worse. Don't allow the patient his delusions. Orient him to reality, even if it is harsh. Don't get angry, defensive or challenge a patient's opinions. These are sure ways to escalate the situation and potentially spawn a physical confrontation. 4. Restraints

Most of the time, restraints should be avoided. They can lead to negative outcomes for patients, both mentally and physically. Sometimes there is no choice but to restrain a patient, but every other therapeutic intervention should be exhausted before resorting to such an extreme action. Restraints have been shown to cause injury and can even lead to death, according the Joint Commission. This intervention should be used only if the patient is going to harm himself or others and there is no way to communicate with him to inhibit his actions. Guidelines for use of Touch Touch is an effective method for communicating a sense of caring. Touch, no matter how well intended, may sometimes be misinterpreted by a client. Therefore, it is wise to avoid touching clients who are suspicious, hostile, or very confused. THERAPEUTIC COMMUNICATION

Practicing therapeutic communication is in many ways simply developing a good bedside manner. When your patient asks you a question or discusses something with you, be careful to respond in a helpful and caring manner. By encouraging the patient to speak up, you are probably helping him/her to decrease his level of stress and thereby his recovery time.

Study the techniques discussed in paragraphs 1-15 and 1-16. Become familiar enough with them so that they become a natural part of your conversations. When your patient communicates with you, you must be able to correctly observe, evaluate, and respond. Your knowledge, understanding, and skill in human relations will enable you to do so.

Nurse-Client Relationship/ Helping Relationship Two basic goals: 1. Help clients manage their problems in living more effectively and develop unused or underused opportunities more fully. 2. Help clients become better at helping themselves in their everyday lives. Keys to Helping Relationship a. development of trust and acceptance between the nurse and the client b. underlying belief that the nurse cares about and wants to help the client.

http://wiki.answers.com/Q/What_makes_nursing_an_art#ixzz1eoJdWwhm http://www.ncbi.nlm.nih.gov/pubmed/10519682 http://www.brooksidepress.org/Products/Nursing_Fundamentals_1/Search.htm Lippincott Williams and Wilkins http://indonesiannursing.com/2008/09/caring-an-integral-component-of-nursing/